Cost minimization analysis comparing enteral N-acetylcysteine to intravenous acetylcysteine in the management of acute acetaminophen toxicity

Context. Acetaminophen poisoning is one of the most common exposures and causes of poisoning-related fatalities as reported to U.S. poison information centers. Acetylcysteine is indicated for the antidotal treatment of acetaminophen poisoning to prevent or minimize acetaminophen-related hepatotoxicity. Available as either an enteral or intravenous (IV) formulation, both forms of acetylcysteine have been proven to be efficacious. Because of the differences in the acquisition costs and the length of treatment, it is unclear which treatment route is the most cost-effective. Objective. The purpose of this study was to compare the total hospitalization charges associated with patients who received either enteral or IV acetylcysteine therapy. Materials and methods. A retrospective, IRB-approved cohort study of patients treated with either enteral or IV acetylcysteine at a university-related hospital for the treatment of acute acetaminophen overdose was conducted. Patients included were over 18 years of age, admitted during the 5-year periods of 1996–2000 (enteral) and 2004–2008 (IV), had an ICD-9 discharge diagnosis for acetaminophen overdose, had no transplant history, and were admitted within 24 h of the overdose. The primary endpoint was the total cost associated with the hospital stay. The Consumer Price Index (CPI) inflation calculator from the U.S. Bureau of Labor Statistics was used to adjust all monetary values to 2008 dollars. Results. Of a total of 1,647 patients, 261 met the inclusion criteria with 70 patients being treated with enteral acetylcysteine and 191 patients treated with IV acetylcysteine. The associated cost was greater in the enteral group than in the IV group ($18,287.63 vs. $7,607.82; p < 0.001). The average length of stay was longer in the enteral group compared to the IV group (7 days vs. 4 days; p < 0.001). Conclusions. Patients who were treated with IV acetylcysteine had a decreased length of stay and cost of hospitalization compared with those patients who were treated with enteral acetylcysteine.